Guide wire torque device

ABSTRACT

A device for gripping a guide wire includes a body portion having an opening therethrough, and has an open position and a closed position. When the device is in the open position the guide wire may be passed through the opening. When the device is in the closed position the guide wire is gripped at more than one location thereby allowing force or torque to be applied to the guide wire. A device according to the invention may optionally, or instead, include (a) a snout to act as a guide wire director, (b) a structure, such as an opening, configured to receive an end of a guide wire package, (c) a structure for securing a body member to the device, and/or (d) a mechanism for advancing or retracting a guide wire. If the device includes one of these optional features, it need not be designed to grip a guide wire at two or more locations.

CROSS REFERENCE TO RELATED APPLICATION

This application claims the benefit of U.S. Utility application Ser. No.10/444,773, filed May 24, 2003, the contents of which are incorporatedherein by reference.

TECHNICAL FIELD OF THE INVENTION

This invention relates to a device for gripping a guide wire in a mannersuch that torque and/or force can be applied to the guide wire to directit during a medical procedure.

BACKGROUND OF THE INVENTION

Certain medical procedures include the use of a guide wire that ispassed through one or more tubular vessels in the body, such as bloodvessels. Among these procedures are (a) percutaneous transluminalcoronary angioplasty (PCTA), wherein a balloon catheter is steeredthrough a blood vessel to a given location and inflated in order todilate a coronary artery, (b) stent or stent graft insertion, (c) bloodvessel stripping, (d) blood vessel harvesting, (e) angiography, and (f)percutaneous transluminal angioplasty.

For procedures involving a blood vessel the guide wire is typicallyintroduced into a vessel via an opening made by a surgeon. For example,a guide wire may be introduced through a small needle hole made in thefemoral artery in the groin area. The guide wire may then be maneuveredthrough the femoral artery and aorta and into branches of the vascularsystem until it reaches the desired location in the desired vessel.Maneuvering the guide wire requires the surgeon to apply torque to theend of the wire outside of the body (the “proximal end”) to twist orrotate the wire, thereby changing the position of the end of the wireinside the body (the “distal end”) to guide it into openings to branchvessels.

Guide wires often have a slippery, hydrophilic coating to provide highlubricity thus allowing the wire to pass easily through an organ, suchas a blood vessel. However, such guide wires may be so slippery thatsufficient torque cannot be applied by simply rolling or twisting theproximal end of the guide wire between a thumb and forefinger.Consequently, a torque device is needed to grip the guide. wire foradequate torque to be applied.

Traditional torque devices are comprised of a small tube, or bodyportion, having an opening therethrough. At one end of the tube is astructure, such as a collet having four fingers that can be pressedtogether, to grip the guide wire. A screw cap having a hole for thepassage of the guide wire therethrough is secured to the tube, ispositioned over the collet and has a tightened position and a loosenedposition. As the cap is moved to the tightened position, the fingers arecompressed radially inward, gripping the guide wire positioned betweenthem. The guide wire can then be manipulated by turning or twisting thetorque device.

A drawback of known torque devices is that the guide wire can only bethreaded from one end, i.e., through the cap positioned at one end ofthe torque device, which may make the device difficult to thread in theoperating room. Additionally, known torque devices grip a guide wire atjust one location, which does not always sufficiently secure the guidewire to allow the application of adequate torque and/or force forsteering or to pull the guide wire taut during certain procedures, suchas vein harvesting (during which, additional longitudinal displacementforces may be encountered). Additionally, with known torque devices theguide wire must be advanced or retracted by holding the guide wire inone hand, which can be awkward.

In addition, guide wires are packaged for shipping. A commonly-usedguide wire package is a tubular plastic sheath into which the guide wireis placed. Typically, when packaged, an end of the guide wire extendsoutside of an end of the package and a guide wire director is positionedon the exposed end of the guide wire. The guide wire director has afirst end that includes an opening dimensioned to receive the end of theguide wire package, thus securing the director and guide wire duringshipping and handling, and a second end that includes an elongatedsnout, which is used to introduce the guide wire into a lumen, such asthe lumen of a vein or catheter. It would be advantageous to provide atorque device that could be preapplied to the guide wire (rather thanbeing applied in the operating room) and that could be positioned on anend of a guide wire package so it remained positioned thereon duringshipping. It would also be advantageous if a torque device included asnout to assist in introducing a guide wire into a lumen.

SUMMARY OF THE INVENTION

One device according to the invention is a guide wire torque device forgripping a guide wire at more than one location on the wire. The torquedevice has an opening extending therethrough, an open position and aclosed position. When the torque device is in the open position theguide wire may be passed through the opening. When the device is in theclosed position the guide wire is gripped at more than one locationthereby allowing torque and/or force to be applied to the guide wire.

One preferred embodiment of the torque device described above includes abody portion, a first cap secured to a first end of the body portion anda second cap secured to a second end of the body portion. The openingextends through the body portion. A first collet is formed at the firstend of the body portion and a second collet is formed at the second endof the body portion. Each collet includes a plurality of compressablefingers for gripping a guide wire, however, any structure(s) forgripping a guide wire may be used. The first cap engages the firstcollet and may be tightened to the first end of the body portion,preferably by utilizing a threaded connection. When tightened, the firstcap compresses the fingers of the first collet so that the fingers gripthe guide wire. The second cap engages the second collet and may betightened to the second end of the body portion, also preferably byutilizing a threaded connection. When tightened, the second capcompresses the fingers of the second collet so the fingers of the secondcollet grip the guide wire.

An alternate torque device according to the invention includes anelongated snout (or simply “snout”), to assist in straightening and/orguiding a guide wire, such as an angled or J-tipped guide wire, into alumen, such as the lumen of a vein or a cannula, and thus acting as aguide wire director. Such a device is configured to grip a guide wire atone or more locations when in the closed position.

Another torque device according to the invention is configured toreceive the end of a guide wire package. Such a torque device ispreferably mounted to a guide wire extending outside the end of thepackage and the torque device is positioned so that the end of the guidewire package is received in an opening in the torque device. Thissecures the torque device to the guide wire package during shipping tohelp protect the guide wire and the torque device. Such a torque deviceis configured to grip a guide wire at one or more locations when in theclosed position.

A torque device according to the invention may also include a structurefor securing a body member (such as a blood vessel) or other object tothe device, the structure preferably being an annular bump or ridge,wherein the ridge is preferably positioned on an elongated snout of thedevice.

Another torque device according to the invention includes a mechanism,such as a thumb wheel, for advancing or retracting a guide wire. Such adevice may further include an elongated snout, a structure for securinga body member or other object thereto, and grips a guide wire at one ormore locations when in the closed position. In this embodiment the guidewire may be gripped solely by the mechanism or by the mechanism andother structures on the device.

Another device according to the invention includes an opening in thebody portion of the device that exposes a guide wire contained therein.The exposed guide wire can then be advanced or retracted utilizing one'sfinger or thumb.

BRIEF DESCRIPTION OF THE DRAWINGS

A detailed description of the invention will be made with reference tothe accompanying drawings wherein:

FIG. 1 is a peripheral, exploded view of a preferred embodiment of oneaspect of the present invention.

FIG. 2 is a side view of the device shown in FIG. 1 with the componentsassembled.

FIG. 3 is a cross-sectional view of the device shown in FIG. 2.

FIG. 4 is a side view of an alternate cap that may be used with a deviceaccording to the invention wherein the cap includes a snout and astructure for securing a body member or other object thereto.

FIG. 4A is a cross-sectional view of the cap shown in FIG. 4.

FIG. 5 is a side view of another alternate cap to be used with a deviceaccording to the invention wherein the cap includes a structure forsecuring a body member or other object thereto.

FIG. 5A is a cross-sectional view of the cap shown in FIG. 5.

FIG. 6 is a side view of another alternate cap to be used with a deviceaccording to the invention wherein the cap includes a snout and analternate structure for securing a body member or other object thereto.

FIG. 6A is a cross-sectional view of the cap shown in FIG. 6.

FIG. 7 is a side view of another alternate cap that may be used with adevice according to the invention, wherein the cap has an openingdimensioned to receive a guide wire package.

FIG. 7A is a cross-sectional view of the cap shown in FIG. 7.

FIG. 8 is a top view of an alternate device according to the invention,wherein the device includes a mechanism for advancing or retracting aguide wire.

FIG. 9 is a cross-sectional view of the device of FIG. 8.

FIG. 10 is an end view of the device of FIG. 8.

FIG. 11 is a side view of an alternate device according to theinvention.

DETAILED DESCRIPTION OF A PREFERRED EMBODIMENT

Turning now to the drawing where the purpose is to describe preferredembodiments of the invention and not to limit same, a preferredembodiment of one aspect of the invention is device 100, illustrated inFIGS. 1-3. Device 100 is for gripping a guide wire (not shown) used inmedical procedures and for allowing a user (typically a surgeon,cardiologist or radiologist) to provide torque and/or force to the guidewire. Device 100 is preferably comprised of plastic such aspolypropylene or acetal (including AMILUS acetal, supplied by SouthlandPolymers Inc., 14030 Gannet St., Santa Fe Springs, Calif. 90670) orother suitable plastic or other material and preferably has a maximumwidth W of 9 mm or less.

Device 100 comprises a body portion 102 preferably comprised of a firstsection 102A and a second section 102B that snap fit or pressure fittogether, although any method of attachment may be used. Body portion102 could be comprised of a single section or any number of sections;the preferred embodiment of body portion 102 includes two sections forease of manufacturing. In the preferred embodiment, section 102A has alength of about 27 mm and section 102B has a length of about 34 mm,although any suitably-sized body portion and/or body potion sections maybe used.

Body portion 102 may include one or more handling surfaces 102C. Eachhandling surface 102C assists in the handling and manipulation of device100 and may be a raised section on body portion 102, a series of groovesor depressions formed in body portion 102 or any structure formed onbody portion 102 that allows for easier handling and manipulation by auser.

Body portion 102 includes a first end 104 that has a collet 106 and athreaded portion 108. Body portion 102 also includes a second end 110that has a collet 112 and a threaded portion 114. Each collet 106, 112includes multiple (four are shown in the drawing)longitudinally-extending and substantially parallel projections orfingers 116. In the preferred embodiment, each of fingers 116 has across-section approximately resembling ¼ of a circle. Although thepreferred embodiment shows fingers, any structure(s) on the torquedevice suitable for performing the gripping function may be used.Further, if fingers are used to grip the guide wire, any number offingers of any shape can be employed as long as they can grip a guidewire when compressed.

As shown in FIG. 3, on opening 120 is defined through body portion 102,and opening 120 comprises interconnected openings 122, 124, 126, 128,130, 206 and 134. Opening 120 is designed to be sufficiently largeenough to allow the guide wire (a typical guide wire has a diameter ofbetween 0.010 to 0.038 inches) used with device 100 to be insertedthrough device 100 when device 100 is in the open position (as describedbelow) and the width or diameter of opening 120 may vary along itslength. Openings 126, 130 in collets 106, 112, respectively, arepreferably substantially the same size. As used herein, substantiallythe same size means that the collets (or any gripping structure(s) usedto practice the invention) have openings and appropriate structure suchthat they each grip the same guide wire when compressed. In onepreferred embodiment each collet 106, 112 has an outside diameter of4.75 mm and openings 126, 130 each have a diameter of 0.94 mm when fullyopen (i.e., when not compressed), although the invention is not limitedto these dimensions and an opening through which the guide wire passesneed not be cylindrical.

In the embodiment shown, body portion 102 includes a projection 129 anda cavity 132. Projection 129 is received in cavity 132, preferably in asnap-fit manner, to connect sections 102A and 102B.

Device 100 also includes a first cap 200 and a second cap 202 that areeach preferably secured to body portion 102 to allow for easier handlingof device 100 than having the caps completely separate from the bodyportion, in which case device 100 would comprise multiple, loose pieces.(However, one or more caps used with a device according to the inventioncould not be secured to the body portion.) Cap 200 is secured to bodyportion 102 via any suitable means, such as an ultrasonic weld, or asnap-fit (or pressure fit) connection wherein a raised annular ringinside cap 200 is pressed past a raised annular ring on end 104. Thissecures cap 200, but does not tighten it to, body portion 102. Cap 202is secured to second end 110 in the same manner.

In this embodiment, first cap 200 and second cap 202 have the samestructure so only cap 202 shall be described in detail. Cap 202 has anopening 204 leading to a tapered, inner cavity 206 (shown in FIG. 3),and further includes threads in cavity 206. Cap 202 also includes a tip210 having an opening 202A through which the guide wire can pass and cap200 includes a tip 212 having an opening 200A through which the guidewire can pass. First cap 200 and/or second cap 202 may also include oneor more cap handling surfaces 208 to assist in tightening and looseningeach or either of the caps to body portion 102. Each handling surface208 can be any structure suitable for this purpose. Cap 200 is tightenedto body portion 102 by screwing it onto threaded portion 108. Cap 202 istightened to body portion 102 by screwing it onto threaded portion 114.

While caps 200, 202 are shown as screw-on caps, other methods oftightening first cap 200 and second cap 202 to body portion 102 may beused as long as the respective cap, when tightened to body portion 102,compresses the plurality of fingers on the respective collet 106, 112with which the cap is associated to grip a guide wire. For example, oneor both caps may snap onto body portion 102, or the caps may benon-removable screw-on or snap-on chucks that compress the fingers whentightened. Additionally, as previously stated, a device according to theinvention may use any suitable structure for gripping a guide wire; itneed not use collets and caps.

Device 100 is in the open position when first cap 200 and second cap 202are loosened sufficiently (i.e., are each in the loosened position),such that a guide wire may be fed through one of the cap openings 200Aor 202A, through opening 120 and out the other cap opening 200A or 202A.Device 100 is in the closed position when caps 200, 202 are tightened,causing the fingers of the first collet 106 and the fingers of thesecond collet 112 to radially compress such that the collets compressagainst any guide wire present, thereby applying pressure to andgripping the guide wire at two locations (as used herein, “location”means any separate point or area of contact on a guide wire). First cap200 and second cap 202 may be tightened or loosened in any order, or maybe loosened or tightened simultaneously. As shown in FIG. 3, cap 200 isin the tightened position and cap 202 is in the loosened position.

When a guide wire is positioned in device 100 and device 100 is in theclosed position, device 100 can be manipulated by a surgeon or otheruser to provide torque and/or force to the guide wire. Handling surfaces102C and/or 208, if used, assist in the manipulation of device 100. Bymanipulation of device 100 the guide wire can be steered into and passedthrough blood vessels or other body structures. Device 100 may also beused to manipulate a guide wire when only gripping the guide wire at onelocation, but it is preferred that device 100 be used by gripping aguide wire at more than one location in which case greater torque may beapplied to the guide wire.

Therefore, device 100 can grip a single guide wire at more than onelocation. By gripping the guide wire at more than one location, theguide wire is held more securely and greater torque (and hence greateror easier manipulation of the guide wire through a blood vessel) orforce can be transmitted to the wire. Gripping the wire at more than onelocation also yields the added benefit of reduced potential to damagethe wire's coating due to load sharing between the multiple locations.Also, in the preferred embodiment of the present invention, having a capon each side of the device, the guide wire can be easily insertedthrough either side of the device.

FIGS. 4 and 4A show an alternate cap 300 that can also be used topractice the invention. A cap 300 may be used with body portion 102 inplace of cap 200 and/or a cap 300 may be used in place of cap 202. Cap300 includes a snout 400 that extends from a base portion 302. Snout 400includes a structure 404 for securing a body portion (such as a bloodvessel) or other object to cap 300 and a tip 406. In this embodiment,structure 404 comprises an annular bump and a body portion or otherobject is preferably attached to cap 300 via a suture ligature betweenstructure 404 and base 302. In all other respects, a device utilizingbody portion 102 and one or two caps 300 is the same as previouslydescribed device 100.

The purpose of snout 400 (and snouts 400′ (shown in FIGS. 5 and 5A) and400″ (shown in FIGS. 6 and 6A) described below) is to assist the surgeonin introducing a guide wire into a lumen, such as the lumen of a bloodvessel or cannula (particularly the cannula of a luer lock). Any snoutsaccording to the invention must only be sufficiently long and narrow forthis purpose. In the. preferred embodiment snout 400 (and all snoutsdescribed herein) is preferably between ½″-1¼″ in length from the base(here, base 302) to the tip (here, tip 466) and is most preferably about¾″ in length (with one embodiment being 0.754″ in length). The outsidediameter of tip 406 (and the tips of all snouts herein) is preferablyless than 4.5 mm and most preferably about 0.94″. However, the inventionis not limited to these specific dimensions.

FIGS. 5 and 5A show a cap 500 that can be used to practice theinvention. A cap 500 may be used with body portion 102 in place of cap200 and/or a cap 500 may be used in place of cap 202. Cap 500 has asnout 400′ (that as shown has the same configuration as snout 400) andincludes a structure 502 for securing a blood vessel or other object tocap 500, preferably with a suture ligature, a base 504 and a tip 506. Asshown, structure 502 is an annular ridge, but may be any suitablestructure formed on or attached to cap 500 for securing a body member orother object to cap 500. In all other respects, a device utilizing bodyportion 102 and one or two caps 500 is the same as previously describeddevice 100.

FIGS. 6 and 6A show a cap 600 that can be used to practice theinvention. Cap 600 has a snout 400″ (that as shown has the samestructure as snout 400) a structure 602 for securing a blood vessel orother object to cap 600, a base 604 and a tip 606. As shown, structure602 is a bulb formed in snout 400″. A cap 600 may be used in place ofcap 200 and/or a cap 600 may be used in place of cap 202. In all otherrespects, a device utilizing body portion 102 and one or two caps 600 isthe same as previously described device 100.

Structure 404, 502 or 602 is designed to assist in securing a sutureligature to cap 300, 500 or 600, respectively, in order to secure a bodymember (such as a blood vessel) or other object to a device according tothe invention, particularly to assist in the removal of a blood vesselin a vein or artery harvesting procedure. However, any object may besecured to a device according to the invention for any reason and, asused herein, the expression “secure a body member” includes both bodymembers and other objects. Any suitable structure may be formed on ormounted to a device according to the invention for that purpose. In thevein harvesting procedure, securing a blood vessel to a device accordingto the invention may be done prior to straightening the blood vessel.Generally, to straighten a blood vessel, the blood vessel is firstaccessed at two positions, then a guide wire is fed through the bloodvessel and is exposed at both positions, which are called proximal anddistal positions. When harvesting a blood vessel, a torque deviceaccording to the invention is placed on the guide wire at the proximalposition outside of the blood vessel and another device according to theinvention is placed on the distal position outside of the blood vessel.An intravascular catheter is passed over the guide wire and through theaccessed portion of the blood vessel thus supporting the blood vessel.The blood vessel is then secured to a structure 404, 502, or 602 by asuture ligature and the guide wire, catheter and vessel are pulledstraight by applying force to a device to which one or more caps 300,500 or 600 are attached.

FIGS. 7 and 7A show another alternative cap 700 that can be used with adevice according to the invention, wherein the cap can receive the endof a guide wire package. A cap 700 may be used in place of cap 200and/or a cap 700 may be used in place of cap 202 on body portion 102. Asknown to those skilled in the art, guide wires are typically packaged intubular plastic sheaths. Cap 700 has a wide, blunt snout 800 andincludes a tip 802 having an opening 804 that leads to cavity 806.Opening 804 and cavity 806 are dimensioned to receive the end of a guidewire package (not shown). Opening 804 and cavity 806 can be of anyconfiguration suitable for receiving the end of a guide wire package sothat a torque device utilizing cap 700 remains mounted on the guide wirepackage during shipping without causing significant damage to the guidewire. This helps to prevent the guide wire or the device from beingdamaged during shipping or handling. Opening 804 and cavity 806dimensioned according to the guide wire package they are to receive, butin two embodiments cavity 806 is cylindrical and has diameters of 0.118″and 0.154″, respectively. In these embodiments, the depth D of cavity806 is at least as deep as the diameter of cavity 806, preferablygreater than twice as deep as the diameter of cavity 806 and mostpreferably about 2½ times the diameter of cavity 806. Furthermore, cap700 may include a structure for securing a blood vessel or other objectthereto. In all other respects, a device utilizing body portion 102 andone or two caps 700 is the same as previously described device 100.

It will be understood that, although a torque device according to theinvention could include two caps 300, or two caps 500, or two caps 600,it is preferred that a device according to the invention, if it includesone of these caps, only include one. Since these caps each include asnout for directing a guide wire into a lumen, there likely would onlybe a need for only one at one end of a torque device. Further, while atorque device according to the invention could include two caps 700, itis preferred that, if a torque device includes a cap 700, only one cap700 be used because only one end of the torque device would be securedto a guide wire package for shipping.

Any of caps 300, 500, 600 or 700 may include one or more of thepreviously described handling surfaces 208. Furthermore, if a deviceaccording to the invention utilizes a cap 300, 500, 600 or 700, it needonly include one guide wire gripping structure, such as a single one ofthe previously described collets or any other suitable structure forgripping a guide wire. In that case, a body portion with which one ormore of caps 300, 500, 600 or 700 is used may still have two caps, butat least one of the caps would not assist in compressing the guide wire.Additionally, a torque device according to the invention, if it includestwo caps, may have any combination of caps 200, 300, 500, 600 and 700.For example, a device may have body portion 102, a cap 300 and a cap700, and one or both of the caps could function with a collet or otherstructure to grip a guide wire. Moreover, a snout, a structure forsecuring a body part or other object to a device according to theinvention, or an opening or other structure for receiving or connectingto the end of a guide wire package could be formed in the body portionof the device rather than in a cap. In that case, the body portion wouldstill have one or more structures for gripping a guide wire and couldstill optionally have at least one of the previously described caps. Forexample, a torque device may have a body portion that includes only asingle wire gripping structure, such as a collet, a cap 300 thatfunctions with the collet to grip a guide wire, and an opening formed inthe body portion opposite cap 300 wherein the opening is dimensioned toreceive an end of a guide wire package.

Turning now to FIGS. 8-10, an alternate device 900 is shown. Device 900includes two caps 920 and 922 and a body portion 940. Body portion 940may include one or more gripping structures. If included, the grippingstructures would assist in the gripping and manipulation of device 900in the same manner as described with respect to device 100.

Body portion 940 includes a first end 924 that has a collet 926 and athreaded portion 928, and first end 940 as shown has the same structureand function as previously described first end 104. Body portion 940also includes a second end 930 that has a collet 932 and a threadedportion 934. As shown second end 930 has the same structure and functionas previously described second end 11O.

As shown in FIG. 8, an opening 950 is defined through body portion 940,and is designed to be sufficiently large enough to allow the guide wireused with device 900 to be inserted through it when device 900 is in theopen position.

Body 940 is preferably formed in two pieces, 940A and 940B that arepressure fit together, although any method of attachment may be used andbody 940 may be formed of any number of pieces. A cavity C is definedwithin body 940. A thumb wheel 954 is positioned partially inside cavityC and extends through an opening (shown here as a slot) in the outersurface of body 940. Drive wheel 954A is integrally formed with or isattached to thumb wheel 954. Thumb wheel 954 is mounted on an axle 956such that it can be rotated. An idler 958 is mounted to or integrallyformed as part of section 940A so that a gap is formed between drivewheel 954A and idler 958. The gap is of sufficient distance to allow theguide wire G to pass through it while still providing for a pressure fitbetween idler 958 and drive wheel 954A to enable guide wire G to beadvanced or retracted by moving thumb wheel 954, which in turn movesdrive wheel 954A. The purpose of thumb wheel 954, drive wheel 954A andidler 958 is to enable a user to move a guide wire positioned insidedevice 900 without the user having to grip or handle the guide and anystructure in or on device 900 suitable for this purpose may be used.

Device 900 also includes a first cap 920 and a second cap 922 that areeach preferably secured to body portion 940 to allow for easier handlingthan having multiple, loose pieces. In this embodiment, first cap 920and second cap 922 each have the same structure and function aspreviously described cap 202. Alternatively, body portion 940 may beused with one or two of caps 300, 500, 600 and/or 700.

A device according to the invention that includes a mechanism foradvancing or retracting a guide wire may only include one structure forgripping guide wire G when the device is in the closed position.Alternatively, it may not include any dedicated gripping structuresbecause the pressure between drive wheel 954A and idler 958 may besufficient to apply torque to the guide wire and direct it. In thatcase, the mechanism may have an open position in which the guide wiremay be threaded through an opening in the mechanism larger than theguide wire, and a closed position wherein pressure is applied by themechanism to grip the wire. Alternatively, the mechanism may have asingle position and the guide wire may be threaded through the mechanismby advancing it using the mechanism. For example, referring to themechanism shown as the preferred embodiment, the guide wire may bethreaded up to the gap between drive wheel 954A and idler 958 and thenthumb wheel 954 may be turned to advance the guide wire through the gap.

FIG. 11 shows an alternate device 1000 according to the invention. Asshown, device includes a cap 500 and a cap 700. Device also includes abody portion 150 that has an opening 152 in which a guide wire G ispositioned, a center portion 154 and an opening 156 in center portion154. The ends of body portion 150, which engage the caps and (in thepreferred embodiment) include collets for gripping a guide wire in themanner previously described, preferably have the same structure as thoseon previously described body portion 102. A bridge 158 is preferablyformed in the bottom of opening 156 and is preferably a rounded, smoothridge that extends substantially the width of opening 156. Opening 156exposes guide wire G positioned in cavity 152 and a user can advance orretract guide wire G by applying pressure to the exposed guide wire andpressing it against bridge 158. Any structure suitable to create apressure fit between a user's thumb or finger in order to advance orretract a guide wire may be used in place of bridge 158, and thepressure fit may simply be made between the user's finger and the lowersurface of opening 156.

Having thus described different embodiments of the invention, othervariations and embodiments that do not depart from the spirit of theinvention will become readily apparent to those skilled in the art. Thescope of the present invention is thus not limited to any one particularembodiment, but is instead set forth in the appended claims and thelegal equivalents thereof.

1. A device for gripping a guide wire, the device comprising: (a) afirst end, a second end and an opening therebetween; (b) an openposition wherein the guide wire may be inserted into the first end,through the opening and through the second end; and (c) a closedposition whereby the guide wire is gripped by the device at more thanone location.
 2. The device of claim 1 that includes a body portion, theopening extending through the body portion, and one or more caps securedto the body portion.
 3. The device of claim 2 wherein the body portionhas a first end and a second end, and wherein the one or more capscomprises a first cap and a second cap, the first cap being secured tothe first end and the second cap being secured to the second end.
 4. Thedevice of claim 3 wherein the first cap has a tightened position and aloosened position and the second cap has a tightened position and aloosened position, the device being in the open position when the firstcap and the second cap are each in the loosened position, the devicebeing in the closed position when the first cap and the second cap areeach in the tightened position.
 5. The device of claim 2 wherein one ofthe caps has an opening dimensioned to receive an end of a guide wirepackage.
 6. The device of claim 2 wherein one of the caps includes asnout.
 7. The device of claim 2 wherein one of the caps includes astructure for securing a body member to the cap.
 8. A device including astructure for gripping a guide wire wherein the device further comprises(a) an opening through which the guide wire may pass, (b) an elongatedsnout to act as a wire director, and (c) a cavity configured to receivean end of a guide wire package.
 9. The device of claim 8 that furthercomprises a structure for securing a body part thereto.
 10. The deviceof claim 9 wherein the structure for securing a body part thereto ispositioned on the elongated snout.
 11. The device of claim 9 wherein thestructure for securing a body part thereto is an annular ridge.
 12. Thedevice of claim 8 wherein the device can grip the guide wire at morethan one location.
 13. The device of claim 8 that further includes acap, the elongated snout formed on the cap.
 14. The device of claim 8wherein the elongated snout has a length between ¾″ and 1 ¾″.
 15. Thedevice of claim 8 wherein the elongated snout has a tip, the tip havingan outer diameter of 0.200″ or less.
 16. The device of claim 8 thatincludes a first cap wherein the cavity dimensioned to receive the endof a guide wire package is formed in the cap.
 17. The device of claim 16that further includes a second cap, the second cap including the snout.18. A device including a structure for gripping a guide wire wherein thedevice comprises an opening through which the guide wire may pass, thedevice configured to receive an end of a guide wire package.
 19. Thedevice of claim 18 that further comprises one or more caps, wherein atleast one of the one or more caps has an opening dimensioned to receivethe end of the guide wire package.
 20. The device of claim 18 thatfurther comprises a structure for securing a body structure thereto. 21.The device of claim 18 wherein the device can grip the guide wire atmore than one location.
 22. The device of claim 19 wherein the openingis between 0.118″ and 0.154″ in diameter.
 23. A device for gripping aguide wire at more than one location wherein the device comprises (a) anopening through which the guide wire may pass, and (b) a mechanism foradvancing or retracting the guide wire.
 24. The device of claim 23 thatincludes a body portion, the opening extending through the body portion,and one or more caps secured to the body portion.
 25. The device ofclaim 23 wherein the device can grip the guide wire at two locations.26. The device of claim 24 wherein the body portion has a first end anda second end, and wherein the one or more caps comprise a first cap anda second cap, the first cap being secured to the first end and thesecond cap being secured to the second end.
 27. The device of claim 26wherein the first cap has a tightened position and a loosened positionand the second cap has a tightened position and a loosened position, thedevice being in the open position when the first cap and the second capare each in the loosened position, the device being in the closedposition when the first cap and the second cap are each in the tightenedposition.
 28. The device of claim 24 wherein one of the caps has anopening dimensioned to receive an end of a guide wire package.
 29. Thedevice of claim 24 wherein one of the caps includes a snout.
 30. Thedevice of claim 24 wherein one or both of the caps includes a structurefor securing a body portion to the cap.
 31. The device of claim 30wherein one or both of the caps has a structure for securing a veinthereto.
 32. The device of claim 23 wherein the mechanism comprises athumb wheel attached to a drive wheel and an idler, a gap being definedbetween the drive wheel and the idler, the gap sufficiently large toallow for the passage of the guide wire.
 33. A device for gripping aguide wire wherein the device has a cavity for receiving a guide wireand an open portion exposing the cavity.